Provider Demographics
NPI:1114613460
Name:MCNEILL, MICHAELLA CHYENNE
Entity Type:Individual
Prefix:
First Name:MICHAELLA
Middle Name:CHYENNE
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHAELLA
Other - Middle Name:
Other - Last Name:SAUNDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 HOPPE BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2319
Mailing Address - Country:US
Mailing Address - Phone:580-465-1118
Mailing Address - Fax:
Practice Address - Street 1:1300 HOPPE BLVD STE 6
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2319
Practice Address - Country:US
Practice Address - Phone:580-465-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator